Achieving accurate bladder wall and tumor segmentation from MRI is critical for diagnosing and treating bladder cancer. However, automated segmentation remains challenging due to factors such as comparable density distributions, intricate tumor morphologies, and unclear boundaries. Considering the attributes of bladder MRI images, we propose an efficient multiscale hierarchical hybrid attention with a transformer (MH2AFormer) for bladder cancer and wall segmentation. Specifically, a multiscale hybrid attention and transformer (MHAT) module in the encoder is designed to adaptively extract and aggregate multiscale hybrid feature representations from the input image. In the decoder stage, we devise a multiscale hybrid attention (MHA) module to generate high-quality segmentation results from multiscale hybrid features. Combining these modules enhances the feature representation and guides the model to focus on tumor and wall regions, which helps to solve bladder image segmentation challenges. Moreover, MHAT utilizes the Fast Fourier Transformer with a large kernel (e.g., 224 × 224) to model global feature relationships while reducing computational complexity in the encoding stage. The model performance was evaluated on two datasets. As a result, the model achieves relatively best results regarding the intersection over union (IoU) and dice similarity coefficient (DSC) on both datasets (Dataset A: IoU = 80.26%, DSC = 88.20%; Dataset B: IoU = 89.74%, DSC = 94.48%). These advantageous outcomes substantiate the practical utility of our approach, highlighting its potential to alleviate the workload of radiologists when applied in clinical settings.